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Hepatitis A reporting: No fault on RI County’s part, sheriff's officials say

By Deirdre Cox Baker

The Quad City Times August 10, 2009

The lack of proper disease reporting in the hepatitis A outbreak this summer was not the fault of the Rock Island County Health Department, according to the results of an official investigation released Monday.

Rather, the reporting issues lie with Trinity Regional Health System, which did not immediately report a confirmed case of hepatitis A to the health department as required by state law, said Jim Bohnsack, the chairman of the Rock Island County Board.

And according to the investigation report, Metropolitan Medical Laboratory got a positive result on a test for the disease June 17, but Rock Island County was not informed of it until June 26, when an incorrect reporting form that had been used arrived by U.S. mail. The error was not sorted out until July 13, after a staffer in the county health department returned from vacation.

"Trinity dropped the ball," Bohnsack said during a news conference Monday at the County Board conference room in Rock Island.

"I'm confident that Trinity will step up and do what's right," he said. Bohnsack added that he hopes the hospital system will reimburse the county for some of the estimated $159,000 spent to help contain the outbreak. The disease was traced to a McDonald's restaurant in Milan, Ill., where some employees who handled food were diagnosed with hepatitis A.

Kathleen Cunningham, Trinity's vice president of hospital operations, said later Monday that there are many people responsible for reporting diseases such as hepatitis. She added that the hospital system has made internal changes to its reporting system since the problem came to light and is in a continuing dialogue with Rock Island County officials.

"Our joint aim is to look at this whole process and find opportunities for change," she said.

Disease reporting used to be checked daily, but it is now a two-step process at Trinity, Cunningham explained, and involves two people checking the daily records.

The sheriff's department investigation also made note of the fact that when the health department questioned Metropolitan Medical Laboratory about the June 17 test being reported late and on an incorrect form, a lab employee said it did not have hepatitis A on a list of diseases requiring a report within 24 hours. A representative of the lab was not available for comment Monday.

If the reporting system had worked as designed, Bohnsack said the county probably would have had to vaccinate about 50 people against hepatitis A, not the 5,366 individuals who went through the public vaccination clinics held July 20-21 and 27-28.

Cross-training is also necessary at the county level to cover disease reporting when key employees are on vacation. "There's no doubt about that," Bohnsack added.

Further, the county is looking at pushing possible changes in legislation that would update the state's disease reporting process. "Should we continue to allow faxes? Is 24 hours right or should it be 12 hours?" Bohnsack said. That was in reference to a state mandate that confirmed cases of hepatitis A be reported by a telephone call or fax within 24 hours.

The board chairman lauded the health department and said it had practiced for this type of event for three years. "To vaccinate more than 5,000 people in a few days, it was very professional," he said.

The cost of vaccine, which was supplied by the State of Illinois, was $113,000. Other expenses totaled about $48,000. Bohnsack is looking for at least $50,000 from Trinity, noting, "I'd like to see them give us at least $100,000 to help the health department out."

Trinity officials were noncommittal when asked about that possibility.

At least 26 cases of hepatitis A were confirmed in the Quad-City region, including 15 cases in Rock Island County, five in Mercer County and two in Scott County. The cases involved people who visited the McDonald's at 400 W. 1st St., Milan. The restaurant was closed for three days in mid-July and underwent deep cleaning in the wake of the outbreak.

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